SM Neuro Flashcards
1
Q
A patient is experiencing decreased hearing in the right ear. The NP completes both the Rinne and Weber tests. If the patient has Meniere disease, what would be the expected finding on the Weber test?
1. Air conduction is two times longer than bone conduction
2. Bone conduction is two times longer than air conduction
3. The tuning fork sound lateralizes to the right ear
4. The tuning fork sound lateralizes to the left ear
A
4.
2
Q
sx of a brain tumor HA
A
dull persistent HA; always in same spot; accompanied (or not) by N/V, visual disturbances, behavioral changes
3
Q
S/S of a red flag HA
A
Thunderclap HA
“Worst HA of my life”
4
Q
what imaging technique can be used to quickly rule out stroke?
A
CT
5
Q
what are the classic sx of stroke?
A
unilateral weakness, facial drooping, slurred speech
6
Q
what is treatment for stroke based on?
A
type of stroke
7
Q
what are the two main types of stroke?
A
hemorrhagic
ischemic
8
Q
does HTN increase risk for hemorrhagic or ischemic stroke?
A
hemorrhagic
9
Q
does atrial fibrillation increase the risk for hemorrhagic or ischemic stroke?
A
ischemic
10
Q
how do you differentiate a TIA from a stroke?
A
sx are identical at first, but sx resolve w/i 24 hours (most often w/i 1 hr of onset)
11
Q
what does the acronym BE FAST relate to? what does it stand for?
A
sx of stroke
Balance, Eyes, Face, Arm, Speech, Time
12
Q
what are the areas of the brain impacted by stroke?
A
Wernicke’s area
Broca’s area
13
Q
if a stroke affects the Wernicke area of brain, what sx result?
A
receptive aphasia - patient cannot understand what is being said to them
-no longer receptive to that information
*R and W are close together in alphabet
14
Q
if a stroke affects the Broca area of brain, what sx result?
A
expressive aphasia - patient has trouble expressing themselves or forming speech
*B and E are close together in the alphabet
15
Q
-in what population is Wernicke-Korsakoff syndrome present?
-what vitamin is this population depleted of?
*what can low levels of this vitamin lead to?
A
-common in those who use alcohol excessively
-vitamin B-1 (thiamin)
-can lead to damage to both the thalamus and hypothalamus causing confusion, ataxia, and vision abnormalities
16
Q
Type of HA:
Unilateral HA, tearing up/runny nose, occurs same time everyday
A
Cluster HA
17
Q
tx for cluster HA
A
100% O2, CCBs
18
Q
Type of HA:
Unilateral HA, possible visual impairment, temple pain/pulsing, increased ESR
-can cause HA, jaw pain, vision changes, can result in permanent blindness
-pain can come and go, but very severe in nature
A
Giant Cell Arteritis (Temporal Arteritis)
19
Q
what are the sx of giant cell arteritis?
A
Unilateral HA, possible visual impairment, temple pain/pulsing, increased ESR
-can cause HA, jaw pain, vision changes, can result in permanent blindness
-pain can come and go, but very severe in nature
20
Q
tx for giant cell arteritis
A
long-term high dose steroids
21
Q
how do you diagnose giant cell arteritis?
A
temporal artery biopsy
22
Q
is giant cell arteritis managed in primary care?
A
no; refer!
23
Q
a patient with giant cell arteritis is being referred
-what must we as the primary care provider ensure takes place regardless of referral?
A
do not delay starting steroids (long-term high dose steroids)
24
Q
what can temporal arteritis lead to?
A
permanent blindness
25
Type of HA:
occipital HA, typically upon awakening; unilateral
HTN HA
26
tx for HTN HA
evaluate BP management
27
Type of HA:
throbbing, pulsing HA; possible N/V, sensitive to lights or noise; aura; unilateral
migraine
28
Type of HA:
bilateral HA; typically presents with throbbing bilaterally; pressure/tight band
tension HA
29
what is commonly associated with temporal arteritis?
polymyalgia rheumatica
30
what is commonly associated with polymyalgia rheumatica?
temporal arteritis
31
sx associated with polymyalgia rheumatica
-inflammatory disorder
-causes increased muscle pain
-increased inflammatory markers
32
typical prophylaxis for migraine HA
-avoid triggers
-can use betablockers (propranolol); TCA (amitriptyline), anti-epileptic (topiramate = Topamax)
33
abortive tx for migraine HA (ie)
triptan drug class is mainstay ie sumatriptan (imitrex)
34
what population cannot be prescribed a triptan drug for migraine HA abortive tx?
pts with uncontrolled HTN and those on other serotonin meds (SSRI)
-can lead to increased risk of serotonin syndrome
35
pathophysiology of Parkinson's disease
decreased dopamine leads to degradation of basal ganglia leading to progressive sx affecting the NS
36
what neurotransmitter is depleted in those dx with Parkinson's disease?
dopamine
37
typical tx for Parkinson's disease
levadopa/carbidopa = Sinemet
38
what happens if Parkinson med Sinemet is taken for long period of time?
it stops working for Parkinson sx (ineffective)
39
symptoms of Parkinson's disease
-bradykinesia (most debilitating, overall)
-resting tremor
-rigidity
-postural instability (impairments in gate or balance)
40
what disease does Brudzinski sign help to dx?
meningitis
41
what disease dose Kernig sign help to dx?
meningitis
42
what is the Brudzinski sign?
when flexing (passive flexion of neck) back of head, causes hips and knees to flex with it d/t meningeal irritation
43
what is the Kernig sign?
patient cannot extend their knee passing 90 degree angle without pain
-Kernig -- Knee
44
what diagnostic test is conducted if either the Brudzinski or Kernig sign is positive?
refer for emergent spinal tap and admission
45
what characterizes multiple sclerosis?
chronic condition that affects NS characterized by demyelinated lesions in the brain
-causes scaring in brain; affects communication to peripheral nerves
46
sx of MS
weakness, sensory loss, fatigue; vision loss if optic nerve impacted
47
tx for MS
no cure; tx aimed at slowing disease progression
48
goal of Alzheimer's disease tx
no cure; tx aids to slow progression of overall loss of cognitive fx
49
3 A's of Alzheimer's disease
1. Apraxia: inability to carry out movements or gestures
2. Agnosia: inability to recognize familiar faces/people
3. Aphasia: inability to comprehend things ie reading, writing, expression by others
50
what does apraxia mean?
inability to carry out movements or gestures
51
what does agnosia mean?
inability to recognize familiar faces/people
52
what does aphasia mean?
inability to comprehend things ie reading, writing, expression by others
53
what quick assessment tool is used to assess cognitive fx/decline and possible dementia?
Mini Mental Status Exam (MMSE)
54
Order of cranial nerves (what roman numeral):
olfactory
I
55
Order of cranial nerves (what roman numeral):
optic
II
56
Order of cranial nerves (what roman numeral):
occulomotor
III
57
Order of cranial nerves (what roman numeral):
trochlear
IV
58
Order of cranial nerves (what roman numeral):
trigeminal
V
59
Order of cranial nerves (what roman numeral):
Abducens
VI
60
Order of cranial nerves (what roman numeral):
Facial
VII
61
Order of cranial nerves (what roman numeral):
Vestibulocochlear
VIII
62
Order of cranial nerves (what roman numeral):
Glossopharyngeal
IX
63
Order of cranial nerves (what roman numeral):
Vagus
X
64
Order of cranial nerves (what roman numeral):
Accessory
XI
65
Order of cranial nerves (what roman numeral):
Hypoglossal
XII
66
what is the name of this cranial nerve?
I
olfactory
67
what is the name of this cranial nerve?
II
optic
68
what is the name of this cranial nerve?
III
occulomotor
69
what is the name of this cranial nerve?
IV
Trochlear
70
what is the name of this cranial nerve?
V
Trigeminal
71
what is the name of this cranial nerve?
IV
Abducens
72
what is the name of this cranial nerve?
VII
Facial
73
what is the name of this cranial nerve?
VIII
Vestibulocochlear
74
what is the name of this cranial nerve?
IX
Glossopharyngeal
75
what is the name of this cranial nerve?
X
Vagus
76
what is the name of this cranial nerve?
XI
Accessory
77
what is the name of this cranial nerve?
XII
Hypoglossal
78
what is the phrase to help us remember all the cranial nerves (in order)?
Oh, Oh, Oh To Touch And Feel A Great Vein - Ah, Heaven!
79
Is this cranial nerve sensory, motor, or both?
Olfactory
Sensory
80
Is this cranial nerve sensory, motor, or both?
Optic
Sensory
81
Is this cranial nerve sensory, motor, or both?
Occulomotor
Motor
82
Is this cranial nerve sensory, motor, or both?
Trochlear
Motor
83
Is this cranial nerve sensory, motor, or both?
Trigeminal
Both
84
Is this cranial nerve sensory, motor, or both?
Abducens
Motor
85
Is this cranial nerve sensory, motor, or both?
Facial
Both
86
Is this cranial nerve sensory, motor, or both?
Vestibulocochlear
Sensory
87
Is this cranial nerve sensory, motor, or both?
Glossopharyngeal
Both
88
Is this cranial nerve sensory, motor, or both?
Vagus
Both
89
Is this cranial nerve sensory, motor, or both?
Accessory
Motor
90
Is this cranial nerve sensory, motor, or both?
Hypoglossal
Motor
91
what is the phrase to help us remember if the cranial nerves are sensory, motor, or both (in order)?
Some Say Marry Money But My Brother Says Big Brains Matter More
92
symptoms of trigeminal neuralgia
severe, stabbing pain in face down one or more of the three branches of the trigeminal nerve
93
tx for trigeminal neuralgia
Tegretol (most common; but there are other tx)
94
what is a medication that treats trigeminal neuralgia?
Tegretol
95
what are patients at increased risk for if trigeminal neuralgia pain is not under control?
increased risk of suicide
96
what cranial nerve is affected during Bell's Palsy?
CN VII
97
what does every patient need to utilize if diagnosed with Bell's Palsy?
eye lubricant
98
why do Bell's Palsy pts need to utilize eye lubricant?
decreased risk of corneal abrasion
99
what tests are used to assess CN VIII (vestibulocochlear)?
Rinne test
Weber test
100
what cranial nerve does the Rinne test examine?
CN VIII (vestibulocochlear)
101
what cranial nerve does the Weber test examine?
CN VIII (vestibulocochlear)
102
process of the Rinne test
-strike tuning fork and place under pinna which is on the mastoid bump (initial location)
-once patient doesn't hear sound anymore, move tuning fork directly next to ear and see how much longer they hear it
103
normal result of Rinne test
air conduction is going to be two times longer than bone conduction when utilizing tuning fork
*A comes before B
*Air longer than Bone
104
abnormal result of Rinne test
bone conduction is longer than air conduction
105
process of Weber test
after striking, place tuning fork on top of head
106
normal result of Weber test
sound will be heard equally by BOTH ears (there is no lateralization)
107
-abnormal results of Weber test
-once abnormal result obtained, what must be concluded next?
1. lateralize to unaffected ear
2. lateralize to affected or bad ear
-conductive or sensorineural hearing loss
108
conductive hearing loss (Weber test)
-sound of Weber Test will lateralize to the bad ear (affected ear)
*noise heard louder in ear pt currently has issues with
-this issue can be seen physically: cholesteatoma; cerumen impaction
109
sensorineural hearing loss (Weber test)
-sound from Weber test is going to lateralize to patient's good or unaffected ear
-this issue cannot be seen physically: Meniere's disease, age, medication
110
what is cholesteatoma?
collection of skin cells within the ear; can often cause large mass in inner ear that needs surgical removal
111
-what is otosclerosis?
*is it conductive or sensorineural hearing loss?
bones in middle ear become struck in place and they no longer vibrate
-issue we can see (in the middle ear) = conductive hearing loss
112
sx of Meniere disease
-what is our biggest concern?
typical presentation: vertigo, tinnitus, ear pressure; common to see nystagmus
-potential permanent hearing loss d/t degradation of cochlea, which is responsible for relaying sounds to the brain for hearing
113
pathophysiology of Meniere disease
abnormality of the inner ear labyrinth --> leads to vertigo and hearing loss
114
what are the two types of migraines?
Migraines without aura
Migraines with aura
115
common S/S of migraine (6)
possible aura
unilateral
throbbing HA behind eyes
N/V
photophobia
phonophobia
116
what is an aura?
sensory disturbance that typically precedes or occurs during the HA itself
117
how long can migraines last?
couple of hours to three days; disruptive to normal life and function
118
characteristics of migraine w/o aura
-at least 5 HA/MO lasting 4-72hrs
-two of the following:
*unilateral
*pulsating
*moderate/severe intensity
*aggravation by or avoidance of regular physical activity
-in addition, at least one or the following:
*N/V
*photophobia/phonophobia
119
characteristics of migraine w/ aura
-at least 2 HA/MO lasting 4-72hrs
-two of the following:
*unilateral
*pulsating
*moderate/severe intensity
*aggravation by or avoidance of regular physical activity
-in addition, at least one or the following:
*N/V
*photophobia/phonophobia
-clear description of how aura presented
120
medication management of migraines: prophylactic medication classes
-Beta blockers (mainstay therapy)
-TCA (ie amitriptyline)
-Anti-epileptic (topiramate (topamax), valproic acid (depakote)
121
what is the mainstay therapy for prophylactic pharmacologic treatment for migraine HA?
beta blockers
122
when is a prophylactic medication prescribed to migraine patient?
when patient is having significant disruption in day-to-day life ie 4 or more HA per MO or taking abortive meds >2x weekly
123
when should an abortive therapy be taken by a migraine patient?
as soon as patient recognizes HA is occurring
124
abortive medications for migraine:
-mild sx
-more severe sx
-combination analgesics (aspirin, caffeine, acetaminophen); NSAIDs frequently utilized
-"triptan" ie sumatriptan (Imitrex)
125
what patients cannot receive sumatriptan (Imitrex)?
patients with CAD or uncontrolled HTN
126
what should the provider consider ordering for a patient with cardiac issues when trying to prescribe triptans?
ECG
127
if a "triptan" medication ie sumatriptan does not help patient with migraines, can other drugs from same class be used?
Yes
-can often see efficacy with another drug from same class (can switch meds w/i same class as needed to control pt sx)
128
what is the highest risk factor for giant cell arteritis?
age
-tends to occur more as people age (often btw 70-80YO)
129
sx of giant cell arteritis?
-unilateral HA; near temporal region of face
-stereotypical to present with "cord like" temporal artery; warm and tender to the touch
-jaw claudication (pain while chewing)
-vision loss
130
what is a concerning symptoms of temporal arteritis?
-vision loss --> can become permanent
131
things to consider when treating temporal arteritis (how quickly; what is tx?)
-must treat ASAP --> even before diagnostics come back
-high potency steroids
132
how is giant cell arteritis diagnosed?
-inflammatory markers: ESR, CRP (almost always elevated in this condition; not used to make definitive diagnosis)
-temporal artery diagnosis (for definitive dx)
133
-what is polymyalgia rheumatica?
-what condition tends to coincide with polymyalgia rheumatica?
-highly inflammatory condition; pain in large muscle groups of the body
-giant cell arteritis
134
-what is the treatment for temporal arteritis?
-how is treatment altered if visual loss is a sx?
-how long are patients on treatment?
-how quickly do sx resolve on treatment?
-long-term, high dose steroids
-utilize even higher doses of steroids and REFER TO ED
-1-2 years and then will gradually taper down
-quickly!
135
symptoms of cluster headache
-sudden, sharp, unilateral HA behind eye
-severe HA
-more common in males
-common to see nasal drainage and tearing
-may suffer from multiple attacks in the same week
-last minutes to hours in duration
-can be associated w/ alc/tobacco use; pts tend to be restless in nature and diaphoretic
136
what type of headache do these sx describe?
-sudden, sharp, severe
-unilateral
-common to see nasal drainage and tearing
-last minutes to hours; multiple attacks per week
-cluster HA
137
how are cluster HA diagnosed?
no dx tool; based on sx/presentation
138
treatment for cluster HA
1. prophylactic
-CCB (ie Verapamil (Verelan)) is the gold standard
*CCB help vasodilate; can cause some HA sx but MAO is totally different
2. abortive
-sumatriptan (injection) + high flow O2 100% at 7-15L for 20min; can use intranasal lidocaine
139
what is the prophylactic treatment for cluster HA?
CCB - Verapamil (Verelan)
140
what is the abortive treatment for cluster HA?
-sumatriptan (injection)
-high flow O2 at 100% 7-15L for 20 min
-intranasal lidocaine
141
what type of HA can increase risk of suicide?
cluster HA (d/t severe sx)
142
sx of stroke
-"thunderclap HA"
-worst HA of life
143
what does the acronym BE FAST stand for?
Balance
Eyes
Face
Arms
Speech
Time
144
-what diagnostics tests are used for stroke?
-why?
-CT
-can determine hemorrhagic or ischemic (CT's are good at seeing hemorrhage in the brain)
145
TIA
-def
-traditionally d/t what?
-what do sx mimic?
-how long do sx last (typically)?
-what is patient at high risk for?
-intermittent disruption of brain's blood supply; only a temporary disruption
-clot
-stroke
-typically 1 hr; patient expected to return to normal w/i 24 hours
-stroke!
146
what is the difference between TIA and stroke?
-stroke sx don't resolve until stroke is treated; some sx linger
*stroke has residual effects:
receptive aphasia (Wenicke's aphasia)
expressive aphasia (Broca's aphasia)
-TIA sx typically resolve in 1 hr (expected to return to normal w/i 24 hours)
147
what is Wernicke's aphasia?
can't comprehend what is said to them
-type of receptive aphasia
148
what is Broca's aphasia?
can't express thoughts and language; often garbled or incoherent
-type of expressive aphasia
149
what diagnostic test is used for Bell's Palsy?
no dx test; use clinical presentation
150
-sx of Bell's Palsy
-what cranial nerve is affected?
-one-sided facial paralysis (sometimes eye won't shut); drooling, altered taste (sx range mild to severe)
-CN VII (facial)
151
what should be ruled out with presentation of Bell's Palsy?
Lyme's disease
152
what is the cause of Bell's Palsy?
unknown
-possible viral infection w/ remissions and exacerbations
-stress, pregnancy, HTN, Pre-E, DM, resp conditions, obesity --> can all be precipitating factors
153
tx for Bell's Palsy
-understand personal triggers
-start steroids w/i 72 hours of sx onset
-antivirals may be utilized depending on pt
-lubricating eye drops or ointment to protect cornea
154
how quickly should steroids be started for a patient diagnosed with Bell's Palsy?
within 72 hours
155
what diagnostic test is used for corneal abrasion?
Fluorescein staining
156
what are the differential dx for Bell's Palsy?
cerebral infarction, facial nerve trauma
157
how does sarcoidosis present differently than Bell's Palsy?
sarcoidosis has facial paralysis bilaterally
158
what causes the sx of Parkinson's disease?
depletion of dopamine
159
what are the 4 core sx of Parkinson's disease?
1. Bradykinesia
2. Rigidity
3. Resting tremor
4. Postural instability
160
Core sx of Parkinson's Disease: bradykinesia
-def
-inability to do find motor tasks ie zip up jacket or less arm swinging while walking
-slowing of patient's movements: shuffling propulsive gait
161
what core sx of Parkinson's disease must be present for dx?
bradykinesia
162
Core sx of Parkinson's Disease: rigidity
-def
muscles become inflexible, stiff and tight over time
163
Core sx of Parkinson's Disease: resting tremor
-def
tremor that occurs even when patient is at ease/resting
164
Core sx of Parkinson's Disease: postural instability
-def
decreased ability to prevent falls d/t instability and even a freezing gait (usually a later finding)
165
does an essential tremor occur with intent or rest?
intent
166
does a Parkinson's tremor occur with intent or rest?
rest
167
how is an essential tremor managed (tx)?
-BB like propranolol (Inderal)
-regular physical activity
-botulinum toxin (Botox) injections
-severe cases: treated w/ deep brain stimulation, but rarely
168
what things worsen essential tremors?
sexual excitement, nicotine and caffeine worsen
169
how are the symptoms of Parkinson's disease treated?
1. dopamine agonists ie Ropinirole (Requip)
-helps w/ motor sx ie tremor and rigidity
2. levadopa/carbidopa (Sinemet)
-better control over bradykinesia but want to delay using due to wearing off phenomenon
170
how long after starting levodopa/carbidopa medication will the patient start to experience the wearing off phenomenon?
3-5 years
171
can dopamine agonists and levadopa/carbidopa be taken together?
yes, or separate.
172
concussion definition
traumatic head injury when brain tissue is rocked, causing impact against the skull
173
mild concussion:
-sx
-tx
-sleepiness, HA, confusion, dizziness; mostly self-resolving; often requires impact testing and clearance to return to school and sports
-rest, dec screen time, slowly return to normal activity; if pt returns too quickly, can cause worsening of sx
174
severe concussion:
-sx
-managed inpatient or outpatient?
-possible tx
-hypoxia, internal bleeding, death
-inpatient
-phenobarbital to prevent seizure activity from the brain injury
175
what is a patient at risk for after having a concussion?
another concussion
176
MS
-definition
-age group
-course of disease
-demyelination of brain and spinal cord
-20-40
-very unpredictable in nature: go through remissions, exacerbations of sx ie muscle weakness, balance issues, immense fatigue, bladder/bowel incontinence, vision problems
177
what is a common presentation of MS?
vision problems d/t communication to optic nerve being affected
178
once diagnosed with MS, what are patients at high risk for?
other conditions: ie trigeminal neuralgia, optic neuritis, nystagmus, periphlebitis
179
tx for MS
not managed in primary care; referred to neuro
-steroids, DMT (disease modifying therapies)
180
what is optic neuritis?
loss of vision in one eye, pain, reduced color vision, blurred vision, reduction of visual acuity
-related to MS (pt at higher risk for other conditions)
181
Meningitis
-def
-what can cause this infection?
-inflammation of protective membranes and fluid or meninges that surround brain and spinal cord
-bacteria, virus, parasite
182
what are some complications of meningitis?
seizures, hearing loss, memory difficulty, potential future learning disabilities, death (if not appropriately treated)
183
early S/S of meningitis
starting to feel ill; may mimic conditions like the flu (fever, fatigue, body aches)
184
later S/S of meningitis
pt gets sicker; may see confusion, difficulty walking, skin rash, vomiting; severe unrelenting HA, extremely stiff neck, N, photophobia, dec appetite
185
how is meningitis diagnosed?
-Kernig's sign
-Brudzinski's sign
-confirm dx with lumbar punction
186
what is the Kernig sign? what does it help to dx?
-lie on back, lift and straighten a bent let (90deg to 180deg); positive findings = severe stiffness in hamstrings causes inability to straighten leg when hip is flexed at 90deg
-meningitis
187
what is the Brudzinski sign? what does it help to dx?
-lie on back, flex neck (chin to chest); positive findings = instinctively patient will flex hips and knees due to stiffness
188
what causes the Kernig and Brudzinski signs to occur?
inflammation in brain and spinal cord; meningitis
189
R/F associated with meningitis
-vaccination status
-population that lives in community based dwellings (college students)
190
are patients dx with meningitis managed inpatient or outpatient?
inpatient
-IV abx, IV fluids, close monitoring
191
what type of seizure:
commonly dx in childhood; can last 20-30 sec, may appear as if child is daydreaming (blankly stare); traditionally last 10-15 sec
absence seizure
192
what are the sx of absence seizures?
(recollection of incidence?)
commonly dx in childhood; can last 20-30 sec, may appear as if child is daydreaming (blankly stare); traditionally last 10-15 sec
-some pts flutter eyelids or other small movements (finger rubbing, eye fluttering, chewing motions)
-no recollection
193
how are absence seizures diagnosed?
EEG
-triggers often used: sleep deprivation, flashing lights, to try and elicit these seizures during scan
194
what is the hardest type of seizure to capture on EEG?
absence seizure
195
do patients outgrow absence seizures?
yes, they tend to
196
tx of absence seizures
-anti-seizure meds
-ethosuximide (Zarontin)
-Valproic acid (Depakote)
-Lamotrigine (Lamictal)
197
what is the preferred medication for treatment used for absence seizures?
ethosuximide (Zarontin)
198
what is ethosuximide (Zarontin) used to treat?
absence seizures
199
Tonic-clonic seizures
-def
-education
-length of seizure
-recollect?
-convulsion seizure; gran mal (tonic (stiffening), then clonic (convulsing))
-lie patient down, turn on side to avoid aspiration (put nothing into the mouth)
-about 3 min; call 911 if seizure > 5min
-no recollection of seizure
200
treatment for tonic-clonic seizure (4)
-valproic acid (Depakote)
-Lamotrigine (Lamictal)
-Topamax (Topiramate)
-Levetiracetam (Keppra)
201
are seizures treated inpatient or outpatient?
outpatient while working closely with neurology
202
anticonvulsant medications
valproic acid
phenytoin
carbamazepine (tegretol)
gabapentin (Neurontin)
203
Valproic acid
-what is it used to treat?
-what are the SE?
-contraindications
-prevent and tx seizures; can be used alone for absence and complex partial seizures; can be used in combo with other meds to tx other seizure types
-affects appetite, metabolism (common to report weight again 10-15lb in first year), gradual hair loss with long-term (4-6MO) therapy (usually dose related)
-do not prescribe to pts with liver complications (fatal hepatotoxicity esp when doses >100mcg)
-do not prescribe to pregnant pts or those who intend on becoming pregnant
204
Valproic acid
-what tests should be monitored if patient is prescribed this med? how often?
-monitor liver function tests closely and continue to monitor levels until stable and every so often after that
205
Phenytoin (Dilantin)
-what type of drug is this?
-what does it treat?
-used alone or in combo?
-complications
-contraindications
-anticonvulsant
-generalized and complex partial seizures
-alone or in combo w/ other seizure meds
-gingival hyperplasia and hirsutism; can dec effectiveness in birth control
-do not prescribe to pts with liver issues (can be toxic to liver)
*monitor liver function tests
206
Carbamazepine (Tegretol)
-what type of drug is this?
-what is this commonly used to tx?
-how does this drug work?
-within what population is this a good medication to use?
-R/F, subsequent blood work
-anti-convulsant
-trigeminal neuralgia
-lessen pain signals sent to brain; mildly anticholinergic
-elderly (only mildly anticholinergic)
-risk for bone marrow suppression and agranulocytosis; order CBC prior to initiating med and q 3 MO for first year while taking
207
what are patients at risk for when taking carbamazepine (Tegretol)?
bone marrow suppression and agranulocytosis
208
Gabapentin (Neurontin)
-what type of medication is this?
-what is it commonly used for?
-patho
-very important characteristic of this med!!!
-SE
-anticonvulsant
-tx of peripheral neuropathy and postherpetic neuralgia (nerve pain/tingling that occurs after shingles outbreak)
-works in brain by altering electrical activity and working on neurotransmitters
-controlled substance!!!!!
-could be sedating; body will need to adjust to it
209
topiramate (topamax)
-what kind of medication?
-what is it used for?
-SE
-when should this medication be avoided (what patient population?)
-HA medication
-prevention of seizures and prophylaxis for migraines
-weight loss
-avoid prescribing this med in pts with renal or hepatic issues or those with hx of eating disorder
210
medications used to treat headaches (4)
topiramate (topamax)
betablockers
TCAs
"triptan"
211
what medications are used to treat migraine headaches prophylactically?
topiramate (topamax)
betablockers
TCA's
212
what medications are used to treat migraine headaches abortively?
"triptan" it sumatriptan (Imitrex)
213
what is a good medication option to treat a patient's migraines with a preexisting condition of depression?
TCA's (prophylactically, though)
214
what HA/migraine medication can cause increased risk of kidney stones?
topiramate (topamax)
215
what HA/migraine medication should not be prescribed to those with a history of eating disorders?
topiramate (topamax)
216
what HA/migraine medication should not be used in patients with hx of renal or hepatic issues?
topiramate (topamax)
217
what HA/migraine medication is used to treat tension HA?
TCA's
218
when are prophylactic treatments utilized for migraines/HA?
why?
when patient takes abortive therapies >2x weekly.
-avoids rebound HA
219
are all medications in the "triptan" class equivalent? explain.
NO!
-another medication from the same class can work for patient even if original med does not.
220
what is the best abortive therapy for migraine HA?
"triptan" - sumatriptan
221
what are the contraindications of "triptan" medications?
those with uncontrolled HTN; those with CV disease can worsen d/t vasoconstriction
222
-when should abortive therapy be taken by pt?
as soon as HA begins
223
what medication can help with cluster HA (abortive)?
intranasal or subQ sumatriptan
high flow O2 100% 7-15min
intranasal lidocaine
224
what medication can help with cluster HA (prophylactic)?
CCB (verapamil)
225
Levadopa-Carbidopa (Sinemet)
-what disease does this tx?
-why isn't levadopa given by itself?
-when is this med administered during the disease process?
-what symptom does this treat best?
-adverse SE
-Parkinson's disease
-levadopa given by itself is readily destroyed by the body; thus fairly large doses would be needed; when given with carbidopa, allows for lower dose of levodopa = less GI SE, too
-wait to initiate med until sx are interfering w/ quality of life
-bradykinesia
-hypotension
226
Levadopa-Carbidopa (Sinemet)
-wear off phenomenon --> how long after starting med does this phenomenon tend to occur?
-w/i 5 years
227
what is the first line treatment for Parkinson's disease?
Levadopa-carbidopa
228
how is Parkinson's disease treated after the wearing off phenomenon occurs?
not much we can do
229
Dopamine agonists
-example of med
-what is it used to treat?
-SE
-can it be used alongside Sinemet?
-ropinirole (requip), pramipexole (Mirapex)
-used to delay initiation of levadopa
-impulse control issues; leg edema (after initiation); issues with hypotension
-yes
230
Meclizine
-what is meclizine (antivert) used to tx?
-what kind of medication is this?
-SE
-good choice of med for what patient population?
-advantages to this medication
-benign positional vertigo and labyrinthitis
-antiemetic
-mildly anticholinergic and sedative
-elderly population
-starts to work quickly; lasts for quite awhile in pts system
231
Iron
-what process is iron necessary for?
-what kind of anemia occurs if iron stores are low?
-what are iron prescriptions based on?
-to make healthy and effective RBC
-iron deficiency anemia
-amount of elemental iron
232
Iron
-what is the preferred version of iron used for supplementation?
-how long are iron-deficient patients treated?
-ferrous sulfate
-until pt has med goal lab values + at least 3-6 MO afterward
233
Iron
-how should iron be ingested?
-things to consider/SE
-how is medication administered to peds patients
-on empty stomach and in acidic environment
-stay hydrated; may need stool softener and high fiber diet/commonly causes constipation
-administer with dropper (iron can stain teeth)
234
Vitamin B12 - Cobalamin
-how is route chosen between oral or IM?
-what type of sx occur with vit B12 deficiency?
-choose route based on type of B12 deficiency anemia
-can lead to neurological sx; beefy red tongue
235
what population common has a vit B12 deficiency?
vegans
236
why does Pernicious anemia occur?
-lack of intrinsic factor in stomach needed to absorb oral vit B12
237
is IM or oral vit B12 given to those with pernicious anemia?
IM (lacking intrinsic factor)
238
should vegans receive oral or IM vit B12 if deficient?
oral for 6-12 week
239
what vitamin can become depleted as a side effect of metformin use?
vit B12
